| NPI | 1942842307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C08619) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MD 98886547) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2023-01-19 |